Denovo NT; One Stage Cartilage repair 2012

At this point with almost (3) years of experience using Denovo NT it is clear that most of my patients are choosing this technique over other available methods of cartilage repair. This is true even for those who, on the opposite knee, have had a successful repair using the two-stage ACI technique.  Patients in my practice simply do not elect to have two surgeries when there is high potential for a good outcome with one surgery.

The setup for single stage cartilage repair

This point of view is informed by the results illustrated in this blog, including some remarkable MRI scans. Having said that, we do not have the 10 year outcome data that is available for ACI, and this will continue to remain a fact for at least 6 years to come (the first Denovo NT performed  was in 2007).  Patients in my practice have a busy- not to say hyperkinetic- lifestyle. Even though cartilage repair is now an outpatient, mini-incision, and considerably less costly procedure…it still is difficult to get some people to use crutches, to protect their knee or ankle, to attend physical therapy, or to take simple measure to avoid complications like blood clots. As a rule, when they are offered a quicker and less costly road to recovery, they will take it. And they still want it to be even quicker!

I would also point out that so far in (3) years there has been only one secondary procedure in my Denovo NT patients, and that was early on for a possible infection. No germs were discovered in that case and the patient subsequently did well.  Therefore, the “take-back” to surgery rate is exceedingly low in my series.

This case demonstrates the “single-stage” nature of Denovo NT; The implant is now being approved by some insurance companies based upon MRI evidence alone, as in this case. Therefore, I had the implant ordered in advance, which is crucial.  First, I arthroscoped the knee and verified the location of the lesion, seen here. Note the large flap of cartilage coming off of the lateral femoral condyle. This may cause severe pain.

The flap of cartilage is held in the tweezers, showing the hole beneath.

The incision is less than 2 inches long and the exposure is excellent. Because of the mini-incision, recovery from this type of surgery is essentially the same as an ordinary arthroscopy.

If you take a 15 year view, we have so much more to offer patients at this time as compared to the late 1990s.  There is no question that better imaging, less invasive surgery, better techniques, and a clear understanding of how cartilage can heal has moved the field forward quite significantly.

Denovo NT particulated cartilage in place

Denovo NT particulated cartilage in place